The feasibility and safety of pulsed field ablation for persistent
atrial fibrillation: a prospective study
Abstract
Introduction: Pulsed field ablation (PFA) is a novel nonthermal
ablation approach using rapid electrical pulses to cause cardiac cell
apoptosis via electroporation. Our study aims to investigate the
feasibility and safety of PFA for persistent atrial fibrillation (PeAF).
Methods: 32 consecutive patients diagnosed with PeAF were
enrolled in our study. All patients underwent PFA treatment using the
strategy including pulmonary vein isolation (PVI), left atrial posterior
wall (LAPW) isolation, cavotricuspid isthmus (CTI) block, and mitral
isthmus (MI) block. Acute and follow-up procedure outcomes were
evaluated, and adverse events related to the ablation procedure were
also observed. Results: One-year survival free from atrial
tachyarrhythmia post-ablation was 65.6%. Acute success rates for PVI,
LAPW isolation, CTI block, and MI block were 100%, 100%, 96.9%, and
81.3%, respectively. Eleven cases (34.4%) experienced atrial
tachyarrhythmia recurrence, with 8 cases being atrial fibrillation
recurrence and 3 cases being atrial flutter recurrence. Three patients
underwent repeat ablation. Minor complications were encountered in 4
patients with asymptomatic cerebral lesions. Vagal responses were
commonly observed during the procedure. No severe coronary vasospasm or
severe haemolysis occurred in our cohort. Conclusion: PFA with
the strategy including PVI, LAPW isolation, CTI block, and MI block is
feasible, safe, and associated with a high rate of freedom from atrial
tachyarrhythmia recurrence at 1 year in patients with PeAF.